New

Provider Enrollment Specialist

Gerald L. Ignace Indian Health Center, Inc.
$20.67 - $26.92/HOUR
United States, Wisconsin, Milwaukee
930 West Historic Mitchell Street (Show on map)
Apr 29, 2025
Job Summary The provider enrollment specialist is a key component to the revenue cycle for the Gerald L. Ignace Indian Health Center. The provider enrollment specialist serves as the primary liaison between the Business Office, providers and insurance payers to facilitate proper enrollment and optimal reimbursement rates. The responsibilities include managing the provider enrollment with third-party payors for the providers in the Medical, Behavioral Health and Dental departments. Essential Duties and Responsibilities Process and track provider enrollment applications with Medicare, Medicaid, and commercial insurance payers. Collaborate with Human Resources and Billing departments to ensure successful payor enrollment. Generate regular reports on enrollment status, pending applications and revalidation deadlines. Follow-up timely with payor enrollment applications to ensure providers are enrolled with contracted payers prior to claims billing. Identify payor enrollment issues that may be causing claim rejections or payment delays and coordinate resolution within the billing department. Maintain comprehensive documentation of all enrollment activities within the payor enrollment tracking system Compliatric. Ensure all enrollment materials comply with FQHC requirements and relevant state/federal regulations. Report issues and payer trends to leadership in a timely manner including changes and updates with third-party payor provider enrollment requirements. Multitask and problem solve to navigate multiple systems to ensure timely reporting to leadership. Performs related duties as assigned by the Manager of Practice Billing. Qualifications Minimum of two years of experience with provider enrollment, preferably in an FQHC or community health center environment. Experience with Medicare and Medicaid. Knowledge of CAQH, PECOS, and state-specific enrollment portals. Problem solving. Ability to work independently and within a team environment. Ability to perform under pressure. Education and/or Skill/Knowledge Requires knowledge acquired in a four-year high school, vocational school or equivalent. Experience in EPPIC Systems preferred. Experience with FQHC billing and reimbursement a plus. Must be proficient in English. Must have strong interpersonal skills and strong organizational skills. Must have excellent verbal and written communication skills. Must have a working knowledge and proficiency in MS Excel and MS Word. Other Significant Factors The physical requirements descried here are representative of those that must be met by an employee to successfully perform the essential functions of the job. While performing duties of this job, the employee is regularly required to sit: use hands to manipulate objects, tools or controls; reach with hands and arm; and talk and hear. The employee must frequently lift and or move up to 10 pounds and occasionally lift and or move up to 25 pounds. Specific vision abilities required by this jo b include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. Noise level in the work environment is usually quiet. Work is performed in an office environment, utilizing various office equipment including, but not limited to a computer, copy machine, fax machine, and multi-line phone. Ability to communicate effectively over the telephone, by computer and in person. Ability to perform well in a fast-paced work environment. This is a general outline of the essential functions of this position and shall not be construed as an all inclusive description of all work requirements and responsibili8ties. The employee may be required to perform other job-related duties as requested by the designated work leader(s). All requirements are subject to change over time. All positions a the Gerald L. Ignace Indian Health Center have the responsibility to carry out functions to maintain inspection and survey readiness, participate in Quality Improvement Initiatives, as well as assist in and or provide education for health promotion and disease prevention. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. Gerald L. Ignace Indian health Center (GLIIHC) supports a safe, healthy and drug-free work environment through criminal and caregiver background checks and pre-employment drug testing. GLIIIHC maintains a smoke-free environment.